Starving

Traci Gold. Karen Carpenter. Nicole Ritchie. Heck, even Princess Diana. These women all suffered with eating disorders in the public eye. All from different backgrounds, all with different motivations and drives, and all, for one reason or another, felt the compulsion to control one thing we need to do for survival: eating.

In a Biopsychology course I took, we studied eating disorders. I had many questions: How can someone resist eating when food is pretty much everywhere? Where does the will power come from to refuse eating and don't they feel hungry? Why is it so hard to treat these people-don't you just make them eat?

I contacted Dr. John Pinel, Professor of Behavioural Neuroscience at the University of British Columbia. On top of his impressive credentials, both professional and personal, he's also the author of the textbook used for the course. Of all the areas we covered, he seemed most passionate about the section on eating. He was enthusiastic about offering his assistance. But before answering any of my questions, he asked me a question: "How would you determine a person's 'ideal weight'?"

He felt this question "gets to the heart of the matter you're concerned with." An interview with Dr. Pinel proved to be as thought provoking and interesting as the subject itself.

The Mystery of Anorexia
Most people are aware of anorexia as it's usually our first thought when we see a very thin girl. To be fair, thinness doesn't necessarily mean she's suffering from an eating disorder (remember Dr. Pinel's question.)

Anorexia and bulimia sufferers are termed so when their weight is low and they have a concern or focus on gaining any weight. According to the DSM-IV-TR, to have the diagnosis of anorexia, the person: (1) has a fear of gaining weight; (2) the absence of three consecutive menstrual periods; (3) a refusal to maintain body weight that is normal for persons of their age and height; and (4) a distorted perception of body shape and size.

Eating disorders aren't innate; we're born to want to eat. We learn eating disorders and in order to treat these girls (and boys) effectively, we need to understand exactly how these disorders start and how they're maintained. This means taking a closer look at existing theories about eating and, perhaps, trying to view them in a different light.

Why Do We Eat? Set-Point Theories: Hunger, Glucostatic and Lipostatic
If someone asked you why you eat, you'd most likely give the person a strange look and say, "Because I'm hungry." But what causes our hunger? Three different set-point theories have been developed over the last 70 years.

The first is the set-point theory of hunger. It states we eat in order to rebuild our body's resources when they get low to maintain a homeostatic state. It's the body's way of saying, "Excuse me, if you want me to keep going, you have to put some sustenance in me."

Pinel compares this theory to a heating system: When we turn on the furnace in the winter, the heat will kick in until the thermostat hits the set temperature. Once the desired temperature is reached, the heater won't go on again until the temperature drops again in the house.

During the 1930s and 1940s, two other theories came about. One was the glucostatic theory, which states we eat in order to maintain glucose levels. This theory is a little more believable in that people with hypoglycemia need to maintain a certain glucose level or they crash or pass out.

The other theory is called the lipostatic theory. The focus here is each of us has a set-point for body fat and when we deviate from that set-point, our bodies will produce adjustments in our eating patterns to get back to it. Pinel pokes holes in these set-point theories.

"First, they're inconsistent with the basic eating-related evolutionary pressures as we know them today," he said. "During our ancient ancestors' time, food was scarce. Today there's a McDonald's on every corner and grocery stores are open late. Second, major predictions using these theories aren't confirmed by current research. And third, these theories are deficient because they aren't considering what really triggers people to eat such as taste, learning, or social factors."

People with eating disorders, particularly anorexics, also blow these theories right out of the water. Anorexics are able to ignore any bodily signs of hunger, they prove a low glucose level isn't the only thing making us eat, and they can go far below what their bodies' normal weight would be (with obese people going the opposite way.) So, what theories are available to help us understand eating disorders?

(1) Factors Determining What We Eat
Think of a food you'd die for. Grandma's apple pie with ice cream? Popcorn with loads of butter? Now, how do you think you'd feel if you got that food and ate it right now? I'll bet it would taste phenomenal. This is what Pinel calls the positive-incentive theory. It states we eat for the pleasure of eating: The aroma, the savory taste on our tongues, or the pleasure we feel when the hunger has been satisfied. These are what make us feel hungry.

Now, imagine going to your favorite restaurant where you get the best of the food you love. You've ordered it, now you're sitting there anticipating it: Your tummy is growling, your mouth is watering, and you smell the tantalizing kitchen aromas snaking out from the kitchen. This is what Pinel describes as the positive-incentive value or the anticipated pleasure of eating.

These two theories poke holes in the set-point theories because they state there are also environmental and learning processes involved in why and what we eat. We also develop learned taste preferences and aversions from what we eat, including learning to eat foods that contain the vital vitamins and minerals our bodies need. As you can see, what we eat is determined by many other factors besides maintaining a set-point.

(2) Factors Determining When We Eat
The clock hits noon and you feel the familiar pain in your tummy alerting you it's time for lunch. Ever wonder why that happens? Our bodies go through a great deal of stress to digest food. Hunger pains are actually the digestive system preparing for the food we're going to eat. These pains happen around the same time each day, every day, when we've trained our bodies to expect food. (Pavlov wasn't far off in his conditioning theory for hunger.)

As a point of interest, Pinel stated the best thing to do is to eat several small meals throughout the day so our bodies will still know food is coming but we won't be teaching it to feel hunger at a specific time.

(3) Factors Determining How Much We Eat
How much we eat is greatly determined by our ability to know when we've had enough or satiety. This depends on the volume and nutritive density of the food we're eating. For example, eating a potato would obviously fill us up a lot more than a bag of popcorn. And a plate of pasta would make us feel full longer than a salad.

However, the social setting we eat in influences satiety. Even people with eating disorders tend to eat more when they're out or with others.

(4) The Settling Point Theory
This theory describes the various factors influencing body weight to achieve equilibrium. It states weight remains constant as long as there aren't any long-term changes in factors that influence it (eg: restricting food intake.) Here, changes limit further changes whereas with the set-point theories, changes "trigger a return to the set point."

Positive Incentives for Anorexics
Anorexics or bulimics hold a high positive-incentive value for food because they're obsessed with it. They think and talk about it constantly or prepare it for other people. But they still avoid eating. How can they do this?

Experiments have been done where people have had starvation imposed upon them. The subjects still valued food and their positive incentive for it increased because even when they were given just a tiny bit of food, it tasted fabulous. This doesn't happen with anorexics.

Woods & colleagues found the body is affected adversely at the beginning of a meal to prepare it for what's coming. This is tolerable in a healthy person and, as stated earlier, is really what makes our stomachs growl. In a person who eats very little, it can be painful and unpleasant.

A disturbing example I read about in our textbook was after WWII when concentration camp survivors were re-fed. They'd gone for so long without any food at all that when they were given food again, many died because their bodies couldn't handle preparing for and digesting the very food they needed to survive.

Finally, when family members suspect a problem with eating, the first thing they try to do is "fatten up" the individual. What they don't realize is the person hasn't had any real food for a very long time and trying to force food into them, ends up having the opposite effect. The anorexic eats the food then feels sick because they aren't used to eating (the food itself or the amount of it they eat) which creates an aversion to the food. In the end, the good intentions are actually reinforcing the disorder by turning the anorexic off of food.

What Hope Is There? Treatment Options
Anorexia is much more difficult to treat than other disorders and relapse for the disorder is very high. This group of people are particularly conflicted about getting well and it can be a long frustrating road for family and friends. Treating with antidepressants is a usual step but shouldn't be used on it's own. The drugs merely make one more accepting to treatment by eliminating the depressive state that maintains the self-abusive thought processes.

Anorexics don't only need to re-learn how to eat properly, they also need to get rid of the damaging thoughts that helped to establish and maintain the disorder. The best treatment option seems to be Cognitive-Behavioural Therapy (CBT) focusing on modifying distorted beliefs about food and self-image. In addition, it's highly recommended therapy be taken by family, friends and other close to the patient in order to help them understand the patient's needs. (In most cases, family mealtimes are observed in order to see what sort of activities occur during a mealtime that could trigger a relapse or help to maintain the disorder.)

My Response to Dr. Pinel's Question
Before taking Dr. Pinel's course, I would have said anyone who was so thin you can see their bones has a serious eating problem. But I suppose people have probably made the same analogy about me.

At 5'3", my weight has hovered between 100 - 103 lbs most of my adult life. I've had many people try (and fail) to "fatten me up." I love food and have a healthy relationship with it-I eat small healthy meals throughout the day but I don't deprive myself of anything. I just make better choices. If I want a burger; greasy, salty fries; or a huge slice of cherry pie with a big blob of whipped cream; I'll eat it. I just don't eat them all at once and not every day. Most importantly, I exercise and stay active with my three girls and my baby boy. The supposed ideal weight for me is about 115 lbs. That's what my weight was at seven months into my third pregnancy.

So, I guess what I'd tell Dr. Pinel is I wouldn't judge whether a person's size is normal or not until I know more about their lifestyle, eating habits and energy output. A person can be very thin or a bit larger than their ideal weight chart would tell them they should be but still be healthy and the best weight for them.

It's only when food is a main focus-either by restriction or over-indulgence-that it becomes a problem. As long as we eat to live and not live to eat, it never will be.